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EMR, ESD highly effective for endoscopic resection of early Barrett's esophagus neoplasia
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Both endoscopic submucosal dissection and endoscopic mucosal resection were found to be highly effective for endoscopic resection of early Barrett’s esophagus neoplasia and compared similarly regarding need for surgery, although ESD was found to have a higher complete resection rate.
“In spite of initial technical advantages, ESD does not seem to offer clinical advantages over EMR in terms of need for surgery, neoplasia remission and early recurrence rates. Large volume randomized controlled trials would be required to verify significant differences with an adequate statistical power,” the researchers wrote.
In a prospective, randomized, controlled, single-center trial, researchers compared the efficacy and safety of endoscopic submucosal dissection (ESD) with endoscopic mucosal resection (EMR) in patients with neoplastic BE.
Both men and women aged 18 and older with BE neoplasia were randomized to either receive ESD or EMR (n = 20 in each group) and had early adenocarcinoma (EAC; ≤3 cm) or a focal lesion of high-grade intraepithelial neoplasia (HGIN). The primary outcome was complete resection defined as margins free of HGIN/EAC, while complete remission from neoplasia, recurrences and adverse events were secondary outcomes.
Lesion characteristics were not significantly different between the groups. Although a complete resection rate occurred more frequently in the ESD group compared with the EMR group (10/17 vs. 2/17 patients, P = .01), there was no significant difference in complete remission rates between the groups at 3 months (15/16 vs. 16/17, P = 1). In the ESD group, there were two patients with a perforation during the procedure, while there were none in the EMR group (P = .49). After the procedures, there was one instance of mediastinitis in the ESD group and three ESD and two EMR patients with temporary chest discomfort (P = 1 for both). One patient who had retreatment for a histological residual high-grade intraepithelial neoplasia had local recurrence of moderately differentiated early adenocarcinoma at 16 months post-procedure.
“In view of the similar excellent outcomes after ESD and EMR of early BE neoplasia in this trial and recent uncontrolled series, it seems very unlikely that even large-scale trials will show significant differences in clinical long-term outcome parameters between both methods,” the researchers wrote.
Disclosures: The researchers report no relevant financial disclosures.
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